Division of Clinical Psychology

To request a hard copy of the document please email Member Network Services, including details of the postal address.

This revised version published in 2017 includes amendments addressing the specific issues experienced by people from black and minority ethnic communities in relation to psychosis, and also the relationship between psychosis and social inequality more generally. Other critiques of the report will be addressed in future editions. This revised version of the original edition is dedicated to contributor Steve Onyett who sadly passed away in 2015. His contribution to improving mental health care was immense. We miss you Steve.

Building on the successful Recent Advances in Understanding Mental Illness and Psychotic Experiences( 2000), this report is intended for service users, their friends and families, journalists, policymakers, mental health workers and the public.

Executive Summary

This report describes a psychological approach to experiences that are commonly thought of as psychosis, or sometimes schizophrenia. It complements parallel reports on the experiences commonly thought of as bipolar disorder and depression.

Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.

There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.

Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

In some cultures, experiences such as hearing voices are highly valued.

Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.

For many people the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives.

It is a myth that people who have these experiences are likely to be violent.

Psychological therapies – talking treatments such as Cognitive Behaviour Therapy (CBT) – are very helpful for many people. In the UK, the National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However most people are currently unable to access it and we regard this situation as scandalous.

More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.

Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.

The British Psychological Society believes that services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality.

Understanding Psychosis and Schizophrenia - Launch Event

The power point and pdf versions of the 2014 inaugural launch of the Understanding Psychosis and Schizophrenia document is free for PCMH members to use in service of disseminating and supporting the use of the document’s content. PCMH Members may wish to adapt the presentation to suit local needs. We expect the original author Anne Cooke and the Faculty to be referenced. We trust that the principles of keeping service users, carers and friends at the heart of your work, promoting a psychological framework as well the values of recovery, social inclusion and appropriate interdependence is adhered to in any amended presentations.

Understanding Psychosis Training Materials

Faculty member Anna Solly and assistant psychologist Emily Currell have prepared slides and tutor notes for a one-day training event that anyone can use to communicate the main messages of 'Understanding Psychosis', for example within Trusts. It is free for anyone to download and use, and by kind permission features the original beautiful images by artist Anita Klein. Feel free to adapt the materials to suit your own context. The suggested timings for the day are based on a 9:30am start but can of course be adapted to suit a differently timed session/s.